Stroke patients may benefit from the IRF’s intense therapy focus more than they would from skilled nursing care, the recommendations say

The majority of people recuperating from a stroke should be treated in an inpatient rehabilitation facility, rather than a nursing home, according to new recommendations from the American Heart Association/American Stroke Association.

The new recommendations, released Wednesday, urge stroke patients to receive treatment in an inpatient rehabilitation facility “whenever possible,” unless they have a condition that would require more skilled nursing care.

“If the hospital suggests sending your loved one to a skilled nursing facility after a stroke, advocate for the patient to go to an inpatient rehabilitation facility instead — unless there is a good reason not to — such as being medically unable to participate in rehab,” wrote Carolee J. Winstein, Ph.D., P.T., lead author of the guidelines.

Winstein’s team found “considerable evidence” that stroke patients benefit from a rehab-focused facility’s minimum three hours of daily therapy and “team approach” in the early period after a stroke.

“For a person to fulfill their full potential after stroke, there needs to be a coordinated effort and ongoing communication between a team of professionals as well as the patient, family and caregivers,” Winstein said.

The guidelines, published in Stroke, also encourage stroke patients and their caregivers to insist upon participation in a “structured” education program on preventing falls. That program may include ways to make their homes safer, decreasing the risk of falls linked to medication side effects, and how to safely use wheelchairs, walkers and canes.

For stroke patients, the association recommends “intense” mobility task training to relearn tasks such as climbing stairs, individually tailored exercise programs, speech therapy, balance training, and eye exercises. Rehab providers should also provide an “enriched environment” with computers, books, music and virtual reality games to increase patient engagement.

While the new guidelines are the eighth set to be released by the American Stroke Association, they are the first recommendation developed to specifically focus on rehabilitation, the researchers noted.

Blogger comment:

Interesting generalization.  My brother-in-law just expired a week-a-go from multiple strokes the fatal ones due to three hours of therapy twice per day in a rehab facility.  Of course this just so happens to be the criteria for getting Medicare to pay for the stay.  Making these assumptions is because we are more concerned about getting fair reimbursement than what is justified by each case.  Yes the problem is the method of payment not the aggressive intense therapies wherever it’s provided.  Yes the solution is to pay for an outcome that considers the patient’s full problem list, discharge plan and capabilities.  Both rehab facilities and SNF’s use antiquated eval forms and procedures because we don’t have continuity systems to provide a complete treatment plan.  I have been exposed to this fragmented system for 37 years of owning, operating and consulting with skilled nursing facilities and we must upgrade the capabilities there and the rehab agencies have the same problem … this will not be solved by site neutral reimbursement levels.  It still doesn’t deal with the professional pursuit of outcome not just the income.  There is a need for computer models triggered by the complete problem assessment that lay out therapy interventions based on the outcome goals.  That system exists with cost accounting and charting attached … it is the Caregiver Management System developed and tested in 140 facilities.  Contact me for the details.